Tohoku J. Exp. Med., 2021 May, 254(1)

The Effect of Teriparatide for the Treatment of Multiple Spontaneous Clinical Vertebral Fractures after Discontinuation of Denosumab in a Female Patient with Rheumatoid Arthritis: A Case Report

Yu Mori,¹ Takuya Izumiyama,¹ Naoko Mori² and Toshimi Aizawa¹

¹Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
²Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

Discontinuation of denosumab is associated with the risk of rebound in bone turnover and rebound-associated spontaneous clinical vertebral fractures. This case report presents an 86-year-old woman with rheumatoid arthritis who experienced rebound-associated spontaneous clinical vertebral fractures at 9 months after denosumab discontinuation. Following 5-year bisphosphonate treatment, the patient had 9 injections of 60-mg denosumab every 6 months. Because of tooth extraction, denosumab treatment was discontinued, and raloxifene was administered. At 9 months after the last denosumab injection, the patient experienced severe low back pain. Magnetic resonance imaging (MRI) and radiograph demonstrated clinical fracture at the fourth lumbar vertebra. MRI performed at 3 months after first fracture showed two additional fractures at the second and third lumbar vertebrae. Teriparatide was administered for management of rebound-associated spontaneous clinical, multiple vertebral fractures. Teriparatide was effective for accelerating the fracture healing and suppressing the occurrence of new fractures. However, 2-year treatment of teriparatide did not have suppressive effect of rebound in bone turnover and general bone loss. This case suggested that teriparatide was effective for suppression of new rebound-associated spontaneous clinical vertebral fractures, but not effective in prevention of general bone loss after denosumab discontinuation.

Keywords —— denosumab discontinuation; osteoporosis; rebound effect; spontaneous multiple vertebral fracture; teriparatide

© 2021 Tohoku University Medical Press

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Tohoku J. Exp. Med 2021, 254, 57-61.

Correspondence: Yu Mori, Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo machi, Aobaku, Sendai, Miyagi 980-8574, Japan.

e-mail: yu-mori@med.tohoku.ac.jp